Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2021 Jan 25;16(1):e0245872. doi: 10.1371/journal.pone.0245872. eCollection 2021.
Mental health disparities among transgender and gender diverse (TGD) populations have been documented. However, few studies have assessed differences in mental health symptom severity, substance use behavior severity, and engagement in care across TGD subgroups. Using data from the electronic health record of a community health center specializing in sexual and gender minority health, we compared the (1) severity of self-reported depression, anxiety, alcohol use, and other substance use symptoms; (2) likelihood of meeting clinical thresholds for these disorders; and (3) number of behavioral health and substance use appointments attended among cisgender, transgender, and non-binary patients. Participants were 29,988 patients aged ≥18 who attended a medical appointment between 2015 and 2018. Depression symptom severity (F = 200.6, p < .001), anxiety symptom severity (F = 102.8, p < .001), alcohol use (F = 58.8, p < .001), and substance use (F = 49.6, p < .001) differed significantly by gender. Relative to cisgender and transgender individuals, non-binary individuals are at elevated risk for depression, anxiety, and substance use disorders. Gender was also associated with differences in the number of behavioral health (χ2 = 51.5, p < .001) and substance use appointments (χ2 = 39.3, p < .001) attended. Engagement in treatment among certain gender groups is poor; cisgender women and non-binary patients assigned male at birth were the least likely to have attended a behavioral health appointment, whereas transgender men and cisgender women had attended the lowest number of substance use appointments. These data demonstrate the importance of (1) assessing gender diversity and (2) addressing the barriers that prevent TGD patients from receiving affirming care.
跨性别和性别多样化（TGD）人群的心理健康差距已得到记录。然而，很少有研究评估 TGD 亚组之间心理健康症状严重程度、物质使用行为严重程度和护理参与度的差异。我们使用专门从事性和性别少数群体健康的社区卫生中心的电子健康记录中的数据，比较了（1）自我报告的抑郁、焦虑、酒精使用和其他物质使用症状的严重程度；（2）这些障碍的临床阈值的可能性；以及（3）顺性别、跨性别和非二进制患者参加的行为健康和物质使用预约的次数。参与者为 29,988 名年龄≥18 岁的患者，他们在 2015 年至 2018 年间参加了医疗预约。抑郁症状严重程度（F = 200.6，p <.001）、焦虑症状严重程度（F = 102.8，p <.001）、酒精使用（F = 58.8，p <.001）和物质使用（F = 49.6，p <.001）因性别而异。与顺性别和跨性别个体相比，非二进制个体患抑郁、焦虑和物质使用障碍的风险更高。性别也与行为健康（χ2 = 51.5，p <.001）和物质使用预约（χ2 = 39.3，p <.001）的数量差异相关。某些性别群体的治疗参与度较差；顺性别女性和出生时被分配为男性的非二进制患者最不可能参加行为健康预约，而跨性别男性和顺性别女性参加的物质使用预约数量最少。这些数据表明（1）评估性别多样性和（2）解决阻止 TGD 患者获得肯定性护理的障碍非常重要。
